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LETTER TO EDITOR
Year : 2015  |  Volume : 30  |  Issue : 1  |  Page : 89-90  

18 F-FDG PET/CT imaging in a seldom case of primary malignant melanoma of duodenum


Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication23-Dec-2014

Correspondence Address:
Dr. Rakesh Kumar
Department of Nuclear Medicine and Positron Emission Tomography, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.147560

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How to cite this article:
Jain S, Sharma P, Karunanithi S, Bal C, Kumar R. 18 F-FDG PET/CT imaging in a seldom case of primary malignant melanoma of duodenum. Indian J Nucl Med 2015;30:89-90

How to cite this URL:
Jain S, Sharma P, Karunanithi S, Bal C, Kumar R. 18 F-FDG PET/CT imaging in a seldom case of primary malignant melanoma of duodenum. Indian J Nucl Med [serial online] 2015 [cited 2019 Dec 15];30:89-90. Available from: http://www.ijnm.in/text.asp?2015/30/1/89/147560

Sir,

We present a case of a 35-year-old male presented with pain abdomen and occasional vomiting of 1 month duration. On clinical examination, an ill-defined, firm mass was palpated in the right hypochondrium region with restricted mobility. Ultrasound of the abdomen reported a mass lesion in right hypochondrium likely arising from the duodenum. Biopsy was then performed from the duodenal mass which revealed histopathological features of malignant melanoma. The tumor cells were immunopositive for S100 and HMB45. The patient was then referred for 18F-fluorodeoxyglucose positron emission tomography/computed tomography (  18 F-FDG PET/CT) for staging and to rule out other primary focus. PET/CT revealed a large (10.4 × 7.2 cm) soft tissue density mass involving first, second, and third part of duodenum with intense 18 F-FDG avidity (maximum standardized uptake value (SUV max ) - 14.1). The mass was infiltrating the inferior surface of liver. There was no other 18 F-FDG avid focus on whole body PET/CT which could suggest metastasis or primary site [Figure 1]. He underwent surgical resection and is planned for chemoradiotherapy.
Figure 1: 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed a large (10.4 x 7.2 cm) soft tissue density mass involving first, second, and third part of duodenum (a and b, arrows) with intense 18F-FDG avidity (maximum standardized uptake value (SUVmax) - 14.1) (c and d, arrows) with no other 18F-FDG avid focus on whole body PET/CT which could suggest metastasis (e)

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Malignant melanoma, originating from melanocytes, is not a common tumor and accounts for 1-3% of all malignancies. [1] However, it is the most common metastatic tumor of the gastrointestinal tract, especially the small intestine. [2] Primary malignant melanoma originating in the small bowel, particularly in the duodenum, is extremely rare. [1],[3],[4] Definite diagnosis depends on both careful histologic examination and the use of proper immunohistochemical stains such as HMB45, Melan-A, and S-100 protein. Before making the diagnosis of primary malignant melanoma of the small bowel, thorough systemic examination must be done to rule out the possibility of metastasis from other sites where melanomas preferentially develop such as the skin, retina, anal canal, or under the nail; and less frequently at other locations such as the esophagus, penis, or vagina. Also, there should not be any history of previous removal or spontaneous regression of any atypical melanocytic skin tumor. [5] 18 F-FDG PET/CT in such patients can provide dual advantage. [6],[7] Firstly, it can rule our primary tumor at other more common sites. Secondly, it can accurately stage the disease. Optimal treatment for malignant melanoma is an extensive and curative surgery, if possible, because other methods including adjuvant radiotherapy, chemotherapy, and immunotherapy cannot offer definite treatment outcome. The time of diagnosis and the presence of metastases are supposed major determinants of prognosis. [5],[8] Although 18 F-FDG PET/CT has been found to useful in detecting small-bowel metastases in patients with metastatic melanoma, [6],[9] a case of primary malignant melanoma of the duodenum has not been documented with 18 F-FDG PET/CT. The present case represents the utility of 18 F-FDG PET/CT in the rare primary malignant melanoma of duodenum.

 
   References Top

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Korkolis DP, Apostolaki K, Gontikakis E, Plataniotis GD, Siskos D, Xinopoulos D, et al. Primary malignant melanoma of the duodenum: Aggressive management and long-term survival of an unusual oncologic entity. South Med J 2008;101:836-9.  Back to cited text no. 4
    
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Wade TP, Goodwin MN, Countryman DM, Johnson FE. Small bowel melanoma: Extended survival with surgical management. Eur J Surg Oncol 1995;21:90-1.  Back to cited text no. 8
    
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Prakoso E, Fulham M, Thompson JF, Selby WS. Capsule endoscopy versus positron emission tomography for detection of small-bowel metastatic melanoma: A pilot study. Gastrointest Endosc 2011;73:750-6.  Back to cited text no. 9
    


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